Can nurse ask family to wait outside while doing treatment

Published

I work in a LTCF and we have a resident whose family is terrible. These people are never satisfied and blame staff for any and everything wrong with resident. This family attempts to micromanage everything. We have MD orders that tell us to call family and ask them if it is ok to give prn meds. Now this family wants to be present any time a treatment is done on their family member. My question is do I have the right to ask these family members to step out while Im doing the treatment?

What kind of prns are being used? If pain meds, they need to know that round the clock dosing might be better. If it is for agitation perhaps they had bad experiences. Sounds like they might cause the agitation so push for SW help.

As a family member, and a nurse, I don't mind being in room for many things but personal care should be private. These are dignity issues and the resident/pt. has a right to privacy when certain parts of body are exposed.

I think most family members do not want to see a supp. or foley placed or pericare given. If it is a treatment that does not violate privacy there may be grounds they see to stay. SW should advocate for privacy with he family.

Denying needed care because family is nutty does not seem ethical to me. How do you document this? Family refused to leave so I did not do...

That looks worse than documenting family violated person's privacy and thus needed care not given, but still leaves you as negligent.

When is next care conf? Make sure you have all your guns loaded when you attend. If the POA is not in agreement with the rest of family bickering and agitating your resident you can get teeth in the care plan. You need a good approach to the subject and SW to back you up.

Up Vote Up Vote ×
Specializes in Neuro/Med-Surg/Oncology.

I work in acute care, so it may be different. I would give the PRNs as ordered. I would not be calling the family for permission. If the doc has a problem with it, he needs to get a set and d/c the orders or tell the family to butt-out. But until he does otherwise, utilize what you have.

If you were ever dragged to court, (and it sounds like it is a possibililty with this family) and you deny pt prudent nursing care b/c of the family, you will not have a leg to stand on. Especially of most of them don't have POA.

As for leaving the room, if it's something that is intimate i.e. enema, suppository, toileting, etc, then they should step out for five minutes and your DON should back you up. If it's for something non-invasive, you're probably going to have to suck it up.

Up Vote Up Vote ×
I work in acute care, so it may be different. I would give the PRNs as ordered. I would not be calling the family for permission. If the doc has a problem with it, he needs to get a set and d/c the orders or tell the family to butt-out. But until he does otherwise, utilize what you have.

If you were ever dragged to court, (and it sounds like it is a possibililty with this family) and you deny pt prudent nursing care b/c of the family, you will not have a leg to stand on. Especially of most of them don't have POA.

As for leaving the room, if it's something that is intimate i.e. enema, suppository, toileting, etc, then they should step out for five minutes and your DON should back you up. If it's for something non-invasive, you're probably going to have to suck it up.

Agreed. I would be leery of not giving meds as ordered. I'd give them until the doc officially dc'd them. The doc sounds spineless.

I also would have them step out for anything of an intimate nature. He's entitled to privacy. I wouldn't however push it on something that isn't personal unless they physically interfere with your job. If that's the case I'd advise your NM and get a paper trail going.

I think his family is making him agitated from what you've shared. I really think you need to get social services, etc. involved. I don't see this ending well. Document, document, document.

Up Vote Up Vote ×
Specializes in burn, ortho, med-surg.

by prn i mean our facility protocol for apap,immodium, tussin dm, mom, or bisacodyl. our order from the md is to call family and ask first. nobody has a good report with this family. at one point we weren't allowed to change his foley because the family only wanted the don or adon to do it. the order even went so far as to say if no output send to er. well we did that a couple of times when resident was agitated and pulled on his foley. the local hosp er wasn't too happy about that but we told em it wasn't us it was the family. funny you should ask about the care plan meeting...they just did it yesterday..thatwhere the i wanna be in the room everytime there is a treatment done came from. along witha list of complaints about staff that they observed while they were here. it was amazing what they saw or heard being as they were only in his room. what they don't see is that as long as we have had this resident he has been bedfast and he has not had any skin breakdown. i don't even work that side unless they short and i cover down but somehow they complained about my ipc skills and i haven't covered down in 3 months. go figure

Up Vote Up Vote ×

If there is an order to call the family for every prn, I would call them...if no answer when called I would document I called then give the prn. If an order to call for every treatment, I would do that also. This family is IMO MUCH better then a resident that has no one interested at all even though can be a pain to handle. Perhaps social service, case management etc. can also be involved.

Up Vote Up Vote ×

I didn't realize the order was to call the family. I would do it then and if they don't answer I'd document and give as needed. I wouldn't leave a patient in discomfort if I couldn't reach them.

The family is a lawsuit waiting to happen. The best you can do is document, document, document. Provide the best care to the patient you can and call it a day. I don't think these people would be happy if God himself cared for them and that makes it a losing battle. They are and always will look for problems.

If the DON says they will take care of the foley...let them. Less work for you. If they want the inmates running the asylum that's the price they will have to pay in return.

I can totally understand your frustration and that of the ER. Family members aren't always the best people to have in charge of patient care. Unfortunately patients often suffer in situations like this because families feel they know more when the medical professionals involved. It's wonderful when familes provide support and there's no problem with them questioning but this goes overboard.

I'd still get Social Services involved. It's clear this family isn't coping well by their actions. Clergy might also help. Your employer also needs to set some boundaries. I wouldn't be shipping this poor man off to ER for something that can be handled where he currently is at. Someone needs to intervene for the good of the patient.

If they are complaining about something you did I would rebutt in writing that you didn't even handle the patient at that time. You need to cover yourself and in a paper trail should this ever go to court.

Up Vote Up Vote ×
Specializes in ICU, PICC Nurse, Nursing Supervisor.

my thought is if they want to manage everything the patient has going on ...then maybe they should take the patient home....i hate families like this

Up Vote Up Vote ×
my thought is if they want to manage everything the patient has going on ...then maybe they should take the patient home....i hate families like this

my heart breaks for patients like this one. i'd bet money they are the reason he's agitated.

Up Vote Up Vote ×
Specializes in Med surg, Critical Care, LTC.

So long as the patient/resident can make his or her needs known, they should have the final say regarding family staying for a procedure or not. Most "intimate" procedures, I would venture to guess, they would NOT want their family present for. :twocents:

Blessings

Up Vote Up Vote ×

I'm a cna in ltc. We used to have a family that would come in everyday and write down every move that we made and thing that we said. They would complain about everything. I would always make sure that someone else- lpn or cna- was in the room with me in case the family made a complaint. That way i had a witness that i did nothing wrong. Family members can make our job very difficult, just be sure to treat the resident like any other regardless of the family.

Up Vote Up Vote ×
Specializes in Ortho, Case Management, blabla.
They would complain about everything. .

I think it is kind of funny when people do that. I act professionally and work within my standard of practice ("What would a prudent nurse do?").

I actually enjoy reading a good complaint about the care I give. I've actually only had a couple, but they don't bother me. I'm more prudent than George Bush Sr.

I had a written complaint that singled me out BY NAME that went something along the lines of;

A) I pushed pain meds too fast and made the pt sick

B) I used a writing utensil to push some gauze somewhere on the dressing

C) I caused an IV to go bad by not having IV fluids running

D) I didn't keep her postop pain under control

E) I can't remember E, but there were like 6 complaints after that. And that I'm such a terrible nurse and I should be fired blablablabla

So I wrote a written rebuttal to my manager to these accusations...I even did bullet points, just like the patient did (I don't even remember this patient at all, I actually had to go back to their chart for all this).

A) I never pushed any IV pain meds, so this point is invalid (I checked the MAR, I didn't).

B) I took care of her for 5 hours before she even had surgery, and never had her postop, so there was no dressing, no gauze, etc. So this complaint is a mystery to me.

C) I may have saline locked her to go to the bathroom or something, but according to the documentation the IV was still running to the same site at the time she went to surgery. And they continued to use this same site throughout the surgery. And for a day afterwards (apparently its my fault that I saline locked her 2 days ago to go take a leak and they had to start a new IV on her per hospital policy when the old IV expired).

D) I did not take care of this patient postoperatively, so I had no comment on this complaint.

E) you (allnurses) get the picture.

Basically they took it all out on me. Whatever. Sue me.

I also had a patient complain because I refused to give her evening dose of metformin despite the fact that she hadn't eaten all day and her blood glucose was 82 and she was NPO @ midnight. She literally complained all the way up the chain to the vice president of nursing.

To hell with em, I say..The number one thing in my mind is that my patients COME TO NO HARM. Customer service is number 2. If they complain then that is the way it is. The best thing I can do is keep my mind at peace.

Up Vote Up Vote ×
Specializes in Trauma, Teaching.

I wouldn't ask anyone except the POA for permission for anything. What if they refuse ABC, but the POA gets mad and says you should have done ABC? Is there a committee of family that votes on everything? (insert sarcastic tone here) Just how many people do you have to call for permission for things?

Call the POA and the POA only for every little thing including in the middle of the night until they get the message that some time they're going to have to trust the nurses' judgment. Can we turn him now? Should we give 3 or 4 ounces of juice? How small shall we cut up his meat? sheesh.

Up Vote Up Vote ×
+ Join the Discussion